The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Diagnostic Value of Barium Esophagogram and Bernstein Test in Patients with Esophagitis
No full textFrom the 19th of July to the 19th of October 1999, we conducted a study to evaluate the diagnostic capabilities/benefits of the double contrast barium esophagogram in patients with esophagitis. The sample patients were taken from patients with reflux-type dyspepsia who visited the out patient clinic of the Sub-department of Gastroenterology of the Department of Internal Medicine of the Faculty of Medicine of the University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta. During the duration of study, 32 patients fulfilled the criteria for inclusion, and did not fulfill the criteria for exclusion. All of the subjects underwent double contrast barium esophagogram, Bernstein test, and endoscopy of the upper gastrointestinal tract, as well as biopsy of the lower third esophageal mucosa. The chief complaints for reflux type dyspepsia were found in the following order: pyrosis/heartburn (56.26%), acid/sour taste in the mouth (12.5%), chest pain (9.38%), swallowing disturbance (6.25%), breathing difficulties (6.25%), belching (6.25%), and palpitation (3.12%). From the 32 patients with reflux type dyspepsia that underwent double contrast barium esophagogram, 10 patients (31.25%) were found positive for esophagitis, and the remaining 22 patients were found to be negative (68.75%). Bernstein test found 11 patients (34.37%) positive and 21 (65.63%) negative, while endoscopy of the upper gastrointestinal tract showed positive esophagitis in 25 patients (78.13%) and negative in 7 patients (21.87%). The degree of accordance between double contrast barium esophagogram and the Bernstein test or even a combination of the two was unsatisfactory in diagnosing esophagitis in reflux type dyspepsia. Based on this, this study concludes that double contrast barium esophagogram and Bernstein are incapable of replacing endoscopic examination in establishing the diagnosis of esophagitis. Keywords: esophagitis, esophagogram, Bernstein tes
The Pathogenesis and Diagnosis of Bile Reflux Gastropathy
No full textBile reflux gastropathy is a disease caused by reflux of duodenal fluid to the gaster. This fluid contains pancreatic juices and duodenal secretion. The manifestations that occur depend on the frequency, amount, and duration of reflux. This disorder is quite rarely recognized in daily clinical practice. Endoscopy of the upper gastrointestinal tract is required to establish the diagnosis of this disorder. This paper will give a brief view of the pathogenesis and diagnostic method for this disorder. Keywords: gastropathy, bile reflux, motilit
The Role of Gastric Acidity and Lower Esophageal Sphincter Tone on Esophagitis in Patients with Dyspepsia
No full textBackground: Esophagitis implies an organic damage of the esophagus due to several pathophysiologic factors, predominantly: (1) degree of gastric acid secretion (gastric pH), whereabouts are rapidly or slowly to be mucosal breaks onto esophagus were under the influenced by: (a) gastric pH £ 4 and (b) the contact of gastric acid into esophageal mucosal. (2) Lower esophageal sphincter (LES) as a important factor for antireflux mechanisms, which antireflux mechanism cannot serve as a barrier system whenever tone of LES comes down until £ 10 mmHg that causes feeble resting LES pressure. Esophageal injuries are recognized endoscopically by the presence of the Savary-Miller’s classification (1985), but there are not definitely which ones principally to pathophysiologic factor.Methods: This was a consecutive non-random sampling cross sectional study. Thirty subject from 127 patients with dyspepsia undergoing elective upper-endoscopic examination with collecting of the gastric juice and biopsies of lower esophageal mucosal, also esophageal manometric examination. Before that, clinical inclusive and exclusive criterias until laboratory examination were performed. Significant interval was 95%. Analyzing data with Fisher’s Exact Test One-Tail to correlate between gastric pH and hypotonic LES into esophagitis. Results: Esophagitis prevalence was 22.8%. Fisher’s Exact Test One-Tail to correlate esophagitis with gastric pH £ 4 was significant (p=0.013798), but with hypotonic LES (tones of LES £ 10 mmHg) was not (p=0.60269). The combined roles of gastric pH and tones of LES into esophagitis are included: (1) Frequency of roles of pH £ 4 and hypotonic LES are 48.2%. (2) Frequency of role of pH £ 4 without hypotonic of LES are 33.3%. (3) Frequency of role of hypotonic LES without pH £ 4 are 11.1% and (4) Frequency of esophagitis without roles of pH £ 4 and hypotonic of LES are 7.4%. Conclusions: The sum of gastric pH £ 4 and hypotonic of LES together are more than each separate factor. Onto statistically was significant between esophagitis and gastric pH, but there is no correlation with tones of LES. So, gastric pH plays a more important role than LES. Key words: gastric pH, tones of LES, roles of pH and tones of LES, esophagiti
Benign Recurrent Intrahepatic Cholestases
No full textBenign recurrent intrahepatic cholestasis (BRIC) or idiopathic recurrent intrahepatic cholestasis is a rare case. It is a familial and autosomal recessive. The etiology of BRIC is still unknown. We report the case of a patient with BRIC who suffered from recurrent jaundice 7 times in 7 years that occurred for 1-3 months with spontaneous resolutieon. This patient received ursodeoxycholic acid, cholestiramine and prednisone. And within 2 months, the jaundice resolved together with other complaints. Keywords: cholestasis, autosomal, familia
Diagnostic Problem and Management of Intestinal Tuberculosis
No full textIntestinal tuberculosis, without any evidence of pulmonary or tuberculous infection elsewhere in the body, is still a rare case. Sometimes it is very difficult to make an early and prompt diagnosis for this, because clinical manifestations are varied, unspecific, and mimic other diseases. Examinations, including chest x-ray, tuberculin test, acid-fast stained smear, endoscopic and histological findings may still be inconclusive. Thus, therapeutic trials of anti- tuberculous drugs are advised. We report a case of intestinal tuberculosis with a chief clinical manifestation of chronic diarrhea. There was no evidence of tuberculous infection elsewhere in the body Endoscopic appearance and histological findings were atypical and unspecific. The patient was given anti- tuberculous drugs and responded very well clinically within 2 weeks. Keywords: Intestinal tuberculosis, difficult diagnosis, managemen
Achalasia Carcinoma Sequence
No full textWe report a case of carcinoma of the esophagus in a 58 years old woman with achalasia, who has been diagnosed since 30 years ago, which initiated by surgical treatment (myotomy) and the symptoms recurred since 3 years ago. According to the progress of the disease, malignancy was strongly suspected due to prolonged stasis and mucosal irritation caused by achalasia (achalasia carcinoma sequence). Because of these contributing factors for the development of serious complications such as malignancy, the diagnosis of achalasia must be systematically diagnosed and treated agressively. Surveillance endoscopy in patients with achalasia should be performed every 1-2 years. Key words: achalasia carcinoma sequence, surveillance endoscop
Pancreatic Adenocarcinoma Presenting as Obstructive Jaundice in A Young Woman
No full textPancreatic carcinoma commonly occur in patients over 60 years. It is usually manifested as abdominal pain, jaundice, and pancreatic mass. In this report, a pancreatic carcinoma occurred in young woman is presented. A surgical drainage was done and followed by Whipple resection. However, the patient passed away three month after the diagnosis. Keywords: pancreatic carcinoma, young woman, obstructive jaundice, whipple resectio
Motility Indole Urease as An Alternative Diagnostic Method for Identifying Helicobacter pylori Infection
No full textBackground: The prevalence of Helicobacter pylori (H. pylori) infection in the world is quite high, especially in developing countries. Usually the patient shows no specific symptoms and chronic gastritis therefore becomes chronically infected. The complication of the infection is the development of peptic ulcer, which is a predisposing factor for gastric carcinoma. Early diagnosis is an important step to avoid these complications by providing immediate accurate therapy. Methods: In this study, the CLO, MIU (Motility Indole Urease) tests and culture were conducted on 131 biopsy samples of the stomach antrum mucous tissue taken from chronic dyspepsia patients from several hospitals in Jakarta. In the CLO test, biopsy tissue was put in a small well agar to be incubated at room temperature. In the MIU test the biopsy tissue sample was submerged in the small MIU tube agar with a depth of approximately 2/3 rds from the surface, and then incubated at room temperature. Another piece of biopsy tissue was cultured micro-aerophylically. The CLO and MIU tests are considered positive if the color changes from yellow to red, and are considered negative if there is no color change within 24 hours. Results: Compared to culture, the CLO test demonstrated 38% sensitivity, 96% specificity, 94% positive predictive value and 52% negative predictive value, whereas the Results of the MIU test aga inst culture method showed 76% sensitivity, 89% specificity, 88% positive predictive value, and 78% negative predictive value. Conclusion: The MIU test that showed high sensitivity and specificity, and thus could be further developed as an alternative diagnostic method for H. pylori infection. Keywords: MIU,CLO, H. pylori infectio
Non-Invasive Assessment and Evaluation of Portal Hypertension in Patients with Liver Cirrhosis
No full textUltrasonography examination is an one of examination that can be used to see the abnormality of portal vein system. The technology of ultrasonography examination has further developed especially after using of Doppler ultrasonography which could portray haemodynamic changes from portal vein in liver cirrhosis patient. From this examination we also could predict bleeding. Keywords: liver cirrhosis, portal hypertension, doppler ultrasonograph